Three views were taken of her cervical spine, which included an APLC, LCN and APOM. Upon reviewing these x-rays, discopathy was noted at the C4-5, 5-6 and 6-7 levels (Figure 1). Also noted was cervical hypolordosis. The APOM did reveal a possible erosion defect on the left side of C2 (Figures 2 and 3). The x-rays were then mailed to a Chiropractic Radiologist who concurred with our findings and agreed that additional tests should be carried out to differentiate torturous vertebral artery from an aneurysm.

The patient was then referred to a local diagnostic imaging center for a brain and cranial vertebral junction study. The MR scan revealed an anomalous course of the dominant left vertebral artery, which exhibited a torturous loop between C2 and C3 and results in focal indentation of the C2 body. No evidence of a vascular aneurysm was apparent. Figures 4 and 5 are coronal images demonstrating the anomalous course of the left vertebral artery as it emerges from the C3 foramen transversarium. Above the left C-3 foramen, the artery bends medially and anteriorly and slightly indents the C2 vertebral body. Axial images (Figures 6 and 7) of the cranial vertebral junction demonstrate a slightly anomalous course of the descending segment of the left vertebral artery. The vessel makes an anterior and medial loop between the levels of C3 and C2, slightly indenting the C2 body laterally. There is actual indentation and scalloping of the C2 body laterally on the left side.

CONCLUSION: